Complications, Readmissions, and Reoperations in Posterior Cervical Fusion
Study Design. Retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2012.
Objective. Minimizing the morbidity of posterior cervical fusion can be improved with identification of patient risk factors.
Summary of Background Data. Posterior cervical fusion is an effective technique for treating a variety of pathology. Stability and neurological improvement have been well documented. The increasing frequency of these procedures necessitates further investigation into the factors that may negatively impact perioperative care.
Methods. The American College of Surgeons National Surgical Quality Improvement Program was queried for all patients undergoing posterior cervical fusion in 2011 and 2012. Preoperative and intraoperative variables were investigated for correlation to complications, readmissions, prolonged intubation, reintubation, and reoperation. A frailty-based score was used to assess preoperative risk. Regression models for prediction were performed.
Results. The study identified 5627 patients of posterior cervical fusion in 2011 and 2012. Of these, 2029 patients (36.1%) had any of our identified complications. Transfusion was the most common in 1482 (26.3%) patients. Excluding transfusion, the complication rate was 9.8%. Prolonged intubation greater than 48 hours occurred in 83 (1.5%) patients. Reintubation occurred in 72 (1.3%) patients. Readmission occurred in 398 (7.8%) patients. Reoperation was necessary in 273 (4.9%) patients with postoperative infection being the most common reason. The frailty-based score was shown to be predictive of any of the above events (P < 0.0001). The majority of patients (54.9%) in the group that had complications was found to have a frailty score of 1 or higher.
Conclusion. The predictors for any event included female sex, increased surgical time, combined anterior-posterior procedures, preoperative inpatient status, diabetes, smoking, American Society of Anesthesiologists class 3 or higher, and increasing age. The frailty-based score is a viable option to predict morbidity in posterior cervical fusion.
Level of Evidence: 3